On the application of the sexual identity therapy framework: An answer to critics

Recently a brief portion of the sexual identity therapy framework was attacked by Peter LaBarbera. More broadly, his criticism challenges Christians in counseling: Should a counselor who is Christian insist that clients conform to the counselor’s beliefs?

LaBarbera argues that Christians in counseling should suspend neutrality and require their clients to conform to what the counselor believes. In my view, this confuses the roles of professional counselor versus pastor, respectively.  

He faults the SITF because he says counselors who practice in line with it must affirm behaviors with which they disagree. However, he misreads the intent of the SITF, and in violation of professional ethics, urges professional counselors to act as pastors. If professional counselors acted in this manner then there would be no restraints on ideological coercion from counselors. Here I respond to his contentions and point out the proper application of the SITF. 

The portion in question is here (The entire framework can be read here):

The guidelines do not stigmatize same-sex eroticism or traditional values and attitudes. The emergence of a gay identity for persons struggling with value conflicts is a possibility envisioned by the recommendations. In addition, the recommendations recognize, as do many gay and lesbian commentators, that some people who have erotic attraction to the same-sex experience excruciating conflict that cannot be resolved through the development of a GLB identity (Haldeman, 2002). Thus, for instance, some religious individuals will determine that their religious identity is the preferred organizing principle for them, even if it means choosing to live with sexual feelings they do not value. Conversely, some religious individuals will determine that their religious beliefs may become modified to allow integration of same-sex eroticism within their valued identity. We seek to provide therapy recommendations that respect these options.

First, it is important to understand that the SITF applies to professional counseling and psychotherapy and not to ministry or pastoral counseling. Often when people seek a professionally trained counselor with a graduate degree, they seek an unbiased relationship to discuss their conflicting values and feelings. This neutral stance is provided out of respect for clients’ status as a free moral agent. This, I believe, is a God-given freedom and must be respected, even when the outcome is a choice which is contrary to the beliefs of the counselor. Recently, Saddleback Church pastor, Rick Warren, said it this way: 

The freedom to make moral choices is endowed by God. Since God gives us that freedom, we must protect it for all, even when we disagree with their choices. 

Consistent with this Christian view of persons, all health care codes of ethics require basic respect for the moral autonomy of clients/patients. For instance, the ethics principles of the American Medical Association as applied to psychiatrists state:

The psychiatrist should diligently guard against exploiting information furnished by the patient and should not use the unique position of power afforded him/her by the psychotherapeutic situation to influence the patient in any way not directly relevant to the treatment goals.

Health care providers can exert significant influence over patients and due to the power differential must take special care not to act coercively. This duty falls to all health care providers, Christian and non-Christian alike.

In addition, the American Counseling Association code of ethics reads:

Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants.

These ethics codes apply to health and mental health care providers who enter into professional contracts with clients, may be receiving reimbursement for services from third party or government payers, and are often regulated by state certifying agencies. In other words, these relationships are regulated by several state and federal laws which require sensitivity to activities which could be coercive and damaging to clients of all belief systems. Christians who are professionally trained and credentialed are not exempt from these considerations because they of their religious beliefs and loyalties. The sexual identity therapy framework was written with this professional audience in mind.

In the ethics codes and the SITF, there is provision for counselors who cannot take a neutral stance. As noted in the SITF, sensitive referral is an option:

The need for referral can arise for reasons involving therapeutic capability and value conflicts. Therapists who rarely conduct sexual identity therapy may find their knowledge and skill base challenged by the needs of some clients.

Therapists who find themselves disappointed by a client’s choices or who even attempt to dissuade a client from pursuing a particular integrative course should secure consultation and consider referral. Moreover, if a therapist’s value position or professional identity (e.g., gay affirming, conservative Christian) is in conflict with the client’s preferred direction, the referral to a more suitable mental professional may be indicated (Haldeman, 2004). Therapists considering referral must take care to consider the therapeutic alliance and any institutional difficulties which might occur due to the referral. Referral may generate charges of discrimination and trigger legal or clinical liability exposure in certain cases (Hermann & Herlihy, 2006). When referral seems clinically appropriate, legal counsel and consultation with one’s liability insurer should be considered.

Akin to the conscience clauses for medical and pharmacy professionals, the referral option acknowledges that counselors may not be able to work against their deeply held beliefs and commitments in their professional work.

Those who believe Christian counselors should be free to take a more pastoral role and direct clients should consider an implication of that perspective. Consider the case of a Christian client who seeks counseling with a moral conflict from a non-Christian counselor. Under the current codes of ethics, the counselor must be sensitive to the client’s faith. However, if coercion and imposition were permitted, then the counselor would be on safe ground to recruit the client away from Christianity and to another faith or no faith.

Much of my work in recent years has been to persuade the professions that respect for religious liberty requires that the professions respect the choices of religious clients. In the area of sexual identity, this means that clients who do not affirm same-sex behavior can be supported to live in accord with their conscience. In August 2009, the American Psychological Association released a task force report which supported such religious clients.

Consistent with respect to conscience and professional ethics, Wheaton College Provost, Stanton Jones, endorsed the SITF, saying:

Throckmorton and Yarhouse have advanced a masterful synthesis of best practice in the confusing and troubled area of sexual orientation, sexual identity, and personal values.  No one should be forced toward a resolution of personal identity that violates their personal conscience; our commitment to being guided by the findings of scientific inquiry and respect for client autonomy and religious freedom should lead us toward empowering individuals to make informed choices about their lives. These guidelines are consistent with the ethical principles of the major mental health professional organizations and are superior to any other existing guidelines for practice in this area. 

In contrast, ministers are able and expected to operate with a more directive stance. Religious leaders are expected to lead and guide according to their understanding of their faith system. When people seek help from them, they expect such guidance. Often people seek the services of both counselors and clergy and each has a role to play in working toward resolution.

To sum up, the SITF is written as a guide to professionals who operate in a legal environment which is open to people of all faiths and no faith. Mr. LaBarbera’s stance confuses roles and if applied to professional Christian therapists across the board would expose them to significant liability.

UPDATE: My friend and co-author, Mark Yarhouse, weighs in on this discussion on his blog. His treatment of this issue is more detailed than mine and well worth the read.

  • Michael Bussee

    Should a counselor who is Christian insist that clients conform to the counselor’s beliefs?

    I think not — at least not in a professional setting. Even in pastoral counseling, I think this would be ill-advised. The same would apply to a non-Christian counselor or a counselor of no faith .Good counseling is not about insisting that clients comform to the beliefs of the counselor.

    Christians who are professionally trained and credentialed are not exempt from these considerations because they of their religious beliefs and loyalties.

    I agree. The same would be true of professional counselors of any faith — or no faith. There may be times when the counselor “may not be able to work against their deeply held beliefs and commitments in their professional work” and that’s when the referral option is appropriate.

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  • Eddy

    Warren–

    I understand and agree with the difference between a pastoral counselor and a professional. I believe that the pastoral counselor can and should be a bit more directive and shouldn’t be expected to take a totally neutral stance. However, I’m puzzled…why would a professional Christian counselor bill himself or herself as such? If there’s no expectation of injecting values–and if the code of ethics for all professionals is against injecting personal values–why the labelling of ‘Christian counselor’? What’s being implied in the use of that label?

  • Michael Bussee

    Perhaps to attract Christian customers and facilitate referrals for folks who are looking for that. I often had Christian clients at the hospital ask for such a referral. They wanted a professionally trained, licensed therapist who understood, supported and shared their faith. They expressed some worry that a non-Christian therapist might try to “talk them out of it”. That’s one possible explanation.

  • Eddy

    Thank you.

    They expressed some worry that a non-Christian therapist might try to “talk them out of it”.

    By ‘it’ do you mean their faith? From the clear professional guidelines this would be incredibly unethical. Makes me wonder: are their fears totally without merit?

    Warren,

    Anything you have by way of response.

  • Timothy Kincaid

    Was anyone under the misimpression that Peter LaBarbera cared one whit about professional ethics?

    ;)

  • http://na Carroll

    I concur with Eddy’s comment. Why call yourself a Christian counselor if you do not counsel from biblical truth. I understand the professional code of ethics and it is not that you counsel to change necessarily but behave in accordance with the truth. But to counsel that religion/truth can be modified to be congurant with behavior is essentially to say truth does not exist or that truth is in the eyes of the one looking not God stating. Again I am not trying to be antagonistic but I do think it is inconsistent for a Christian counselor to counsel from anything other than the Christian perspective. Perhaps this is not well said but I think it is fairly clear and would be appreciative of a reply.

    Many thanks.

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  • Robert Mann

    In the above writing your present the potential conflict between Christian beliefs and a professional code of ethics. How can ethics exist apart from Christ? How can you exclude Christ from your workplace in the name of ethics? Your issue is not a question of the higher moral ground, but of whom you choose to serve – Jehovah or Nebuchadnezzar?

  • http://www.patheos.com/blogs/warrenthrockmorton Warren

    Robert – Is it ethical to respect the freedom of persons to choose their moral course? Or would it be ethical to use the power relationship of the therapist to coerce a client to do something against his will?

  • Alesya

    It is sometimes hard to believe how little people know about the profession of psychologist. They are fed by stereotypes from media and hollywood movies, and offten have no idea that psychologysts folow code of ethics. :)


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